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06 May 2003

HIV and older people

A common misconception is that HIV is not an issue that relates to older adults (those over the age of 50). We tend not to think of older people as being sexually active or using drugs, and therefore not at risk for infection.

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HIV infection among older adults
A common misconception is that HIV is not an issue that relates to older adults (those over the age of 50). We tend not to think of older people as being sexually active or using drugs, and therefore not at risk for infection. Aids awareness and prevention campaigns tend to target the young, and older people with HIV/Aids become an “invisible” group. Although it is true that most new infections are occurring among young people, many older people are sexually active.

Studies show that factors which further increase risk, such as multiple sexual partners, sexually transmitted diseases, and alcohol or drug use, are also not uncommon in older people. And, as newer drug therapies help younger HIV-infected people to live longer, the over-50 population of people with HIV/Aids will continue to grow.

The stigma attached to older people with HIV/Aids
Older people living with HIV/Aids often face a double stigma: that of being HIV-positive, and that of being older. Some sectors of society have the ageist view that it is not “proper” for older people to be sexually active. Because of the stigma, it can be difficult for seniors to be open about their HIV status.

Resources available to help the HIV/Aids community are often not allocated to older people. This may in part be the result of prejudicial attitudes that consider it a “waste” to spend money on the elderly, as they have already lived their lives and thus it is of little importance if they die from Aids. Lack of awareness about how HIV/Aids affects older adults may also explain why, in general, there has been a lack of focus on this segment of the population in terms of HIV/Aids research, clinical drug trials, and prevention programmes.

Ageist attitudes among members of the medical profession can also hinder prevention (and diagnosis – see below) of HIV in older people. Doctors may be less likely to ask older patients about their sexual activity or drug use, and to provide prevention information as they would with younger patients.

The difficulty of diagnosing HIV in older people
One of the problems in diagnosing HIV in older people is that certain symptoms of the infection (such as fatigue, memory loss, shortness of breath, sleeplessness, weight loss and digestive problems) are very similar to, and often mistaken for, signs of normal ageing.

In addition, doctors often do not look for sexually transmitted diseases in older patients because of the myth that they are no longer sexually active. The result is that older adults with HIV are typically diagnosed at a later stage of infection than younger people, and thus miss out on the benefits of early treatment.

Infection risks of special significance to older people
In some respects, older people may be at greater risk for infection. Older people may view condoms mainly as a contraceptive measure, and women past reproductive age may not insist on their use.

Post-menopausal women may be particularly susceptible to HIV-infection because the vaginal walls become thinner, and vaginal lubrication is often reduced. Older women may therefore be more vulnerable to vaginal trauma during intercourse, which increases risk for HIV transmission.

Antiretrovital drugs and the older patient
Few studies have compared survival rates between younger and older HIV-infected people, but evidence suggests that older people fall ill with Aids-related complications sooner, and die sooner. This may in part be due to the fact that people over 50 have weaker immune systems. Also, side-effects of antiretroviral drugs tend to worsen conditions associated with ageing, such as high cholesterol and diabetes.

Another area needing further research is how drugs for common age-related conditions, such as high blood pressure and hormone replacement therapy, interact with anti-retroviral drugs.

The burden of HIV on the elderly
The HIV/Aids pandemic, particularly in the developing world, is placing an enormous burden on older adults as it claims the health and lives of their children - adults in their prime productive years. Many elderly people are stepping in as caregivers for grandchildren orphaned by Aids, or whose parents are too ill to provide or care for them.

The elderly, particularly women, must also often nurse their younger HIV-infected relatives and friends. Elderly people may struggle physically, economically and emotionally to cope with the demands of tending a household, caring for the sick and looking after children. Many of the elderly, at risk to their own health, are being forced to seek work and become breadwinners once again, especially in countries without state-funded pensions and welfare systems.

 
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